Original article
General thoracic
Prediction of Prognosis and Surgical Indications for Pulmonary Metastasectomy From Colorectal Cancer

https://doi.org/10.1016/j.athoracsur.2006.02.027Get rights and content

Background

Treatment of pulmonary metastases from colorectal cancer by excision has increased rapidly, but reports on indications and prognostic factors are inconsistent. We sought to identify poor prognostic factors preoperatively and to retrospectively evaluate preoperative clinical indications for surgery.

Methods

A total of 75 patients with colorectal cancer had pulmonary metastases excised from 1986 to 2003. Tumor size, number, laterality, hilar or mediastinal lymphadenopathy, and carcinoembryonic antigen level were possible risk factors for metastatic tumors, with primary site of colorectal tumor, disease-free interval, and hepatectomy for liver metastasis possible risk factors for primary tumors. Prognostic factors in univariate and multivariate analyses also included age and sex.

Results

Five-year survival rates were 41.3% after pulmonary excision and 73.1% after primary colorectal resection. Three factors identified as significant by univariate log-rank test for overall survival after pulmonary resection were carcinoembryonic antigen (p < 0.0001), tumor laterality (p = 0.0205), and number of pulmonary metastases (p = 0.0028). Multivariate analysis found that carcinoembryonic antigen, tumor number, tumor size, and patient’s age were also independent prognostic factors. In contrast, carcinoembryonic antigen, number of metastases, and disease-free interval predicted prognosis after primary colorectal resection. Prior hepatectomy for metastases did not influence prognosis after pulmonary metastasectomy.

Conclusions

Elevated carcinoembryonic antigen level and multiple metastases are preoperative predictors of poor prognosis after resection of pulmonary metastases from colorectal cancer. Survival rate is sufficient to justify pulmonary metastasectomy if there is no local or distant metastatic lesion other than in the liver; if needed, sequential pulmonary and hepatic metastasectomy can be performed.

Section snippets

Patients

A total of 75 patients with primary colorectal cancer, including 38 colon cancers and 37 rectal cancers, had pulmonary metastases excised from 1986 to 2003 at the Department of Thoracic Surgery, Chiba University Hospital (Chiba, Japan); patients were followed up through the end of 2004. Our criteria for resection of pulmonary metastases from colorectal carcinoma included unilateral or bilateral excisable lung lesions per preoperative chest radiography, no local recurrence of primary lesions,

Survival and Univariate Analysis

Overall 5-year and 10-year survival rates were 41.3% and 35.2% from date of pulmonary excision, respectively. Overall 5- and 10-year survival rates were 73.1% and 40.3% from date of primary colorectal resection, respectively (Fig 1). For overall survival after pulmonary resection, three prognostic factors were determined as significant by univariate p value: CEA, p < 0.0001 (Fig 2); tumor laterality, p = 0.0205; and number of pulmonary metastases, p = 0.0028; log-rank test (Table 1). For

Comment

The first and second target organs for metastatic colorectal cancer are the liver or lung. No report has disclosed any data from a well-planned randomized control study comparing surgery and other therapeutic procedures for pulmonary metastasis from colorectal cancer. The reason we selected surgery for these patients is that no effective chemotherapy has been established. Recently, we have encountered many cases of pulmonary metastases from colorectal cancer because of early screening with

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